WHO defines zero-vaccination children as children who have no access to routine immunization services or who are not served by routine immunization services at all. It is operationally measured as a child who does not receive the first dose of DPT (diphtheria, pertussis, tetanus) vaccine. It is primarily used to communicate about immunization gaps and drive concerted efforts to close them. It is calculated as the difference between the estimated number of surviving infants and the estimated number of children who received the first dose of DPT.
Not necessarily. Zero-dose refers to babies who have not received the first dose of DPT, which is given at 6 weeks in India, so most zero-dose babies are likely to have received most or all of the vaccines given at birth. According to the latest National Family Health Survey (2019-21), 88.6% of births take place in institutions or health facilities. However, the proportion of children under two years who received the BCG vaccine against tuberculosis at birth is 95%. This indicates that even children who were not born in health facilities received vaccination services. According to the latest UN estimates, there will be 1.6 million zero-dose babies in India in 2023, up from 1.1 million in 2022. With an estimated 23 million births each year, this means that 6.9% of infants surviving in 2023 will be zero-dose babies.
Vaccines given at or shortly after birth include BCG (at birth or as soon as possible before 1 year of age), Hepatitis B vaccine (at birth or as soon as possible within 24 hours), and Oral Polio Vaccine (OPV, given at birth or as soon as possible within 15 days of birth). At 6 weeks, babies receive one dose of fractionated inactivated polio vaccine (IPV), another dose of OPV (oral rotavirus vaccine), the first of two doses of pneumococcal conjugate vaccine, and the first of three doses of a pentavalent vaccine combining diphtheria, pertussis, tetanus, hepatitis B, and Haemophilus influenzae type b (Hib) vaccines. Thus, it is assumed that if a baby misses the first dose of DPT, they are likely to miss all other doses given at 6 weeks. WHO/UN estimates suggest that missing the first dose of DPT-containing vaccines is understood to indicate a lack of access to routine immunization overall, but this may not be the case.
A Gates Foundation-backed study published in the Journal of the American Medical Association (JAMA) in February 2023 used anonymized data from five waves of India’s National Family Health Survey (NFHS) to look at zero-dose vaccination over a 29-year period (1993 to 2021, see chart). They found that between 1993 and 2021, the proportion of infants receiving zero-dose vaccination fell from 33.4% to 6.6% overall.
In absolute terms, the number of zero-dose children fell substantially in the decade between 2006 and 2016. It fell from around 8.5 million zero-dose children in 2006 to just over 1.6 million in 2016. However, the highest annual relative decline was in the five years between 2016 and 2021, at 7.4% per year. This was after Mission Indradhanush, which aimed to cover all unvaccinated or partially vaccinated children, was launched in 2014. After the COVID-19 pandemic caused setbacks in the vaccination program and the number of zero-dose children reached 2.7 million, India was able to reduce it to 1.1 million in 2022, according to UNICEF estimates. However, the number has risen to 1.6 million in 2023, according to UNICEF.
Not necessarily. Zero-dose refers to babies who have not received the first dose of DPT, which is given at 6 weeks in India, so most zero-dose babies are likely to have received most or all of the vaccines given at birth. According to the latest National Family Health Survey (2019-21), 88.6% of births take place in institutions or health facilities. However, the proportion of children under two years who received the BCG vaccine against tuberculosis at birth is 95%. This indicates that even children who were not born in health facilities received vaccination services. According to the latest UN estimates, there will be 1.6 million zero-dose babies in India in 2023, up from 1.1 million in 2022. With an estimated 23 million births each year, this means that 6.9% of infants surviving in 2023 will be zero-dose babies.
Vaccines given at or shortly after birth include BCG (at birth or as soon as possible before 1 year of age), Hepatitis B vaccine (at birth or as soon as possible within 24 hours), and Oral Polio Vaccine (OPV, given at birth or as soon as possible within 15 days of birth). At 6 weeks, babies receive one dose of fractionated inactivated polio vaccine (IPV), another dose of OPV (oral rotavirus vaccine), the first of two doses of pneumococcal conjugate vaccine, and the first of three doses of a pentavalent vaccine combining diphtheria, pertussis, tetanus, hepatitis B, and Haemophilus influenzae type b (Hib) vaccines. Thus, it is assumed that if a baby misses the first dose of DPT, they are likely to miss all other doses given at 6 weeks. WHO/UN estimates suggest that missing the first dose of DPT-containing vaccines is understood to indicate a lack of access to routine immunization overall, but this may not be the case.
A Gates Foundation-backed study published in the Journal of the American Medical Association (JAMA) in February 2023 used anonymized data from five waves of India’s National Family Health Survey (NFHS) to look at zero-dose vaccination over a 29-year period (1993 to 2021, see chart). They found that between 1993 and 2021, the proportion of infants receiving zero-dose vaccination fell from 33.4% to 6.6% overall.
In absolute terms, the number of zero-dose children fell substantially in the decade between 2006 and 2016. It fell from around 8.5 million zero-dose children in 2006 to just over 1.6 million in 2016. However, the highest annual relative decline was in the five years between 2016 and 2021, at 7.4% per year. This was after Mission Indradhanush, which aimed to cover all unvaccinated or partially vaccinated children, was launched in 2014. After the COVID-19 pandemic caused setbacks in the vaccination program and the number of zero-dose children reached 2.7 million, India was able to reduce it to 1.1 million in 2022, according to UNICEF estimates. However, the number has risen to 1.6 million in 2023, according to UNICEF.
